Patwardhan Utsav, West Erin, Ignacio Romeo C, Gollin Gerald
Rady Children's Hospital San Diego, Division of Pediatric Surgery, 3020 Children's Way, San Diego, CA 92123, USA; Naval Medical Center San Diego, Department of Surgery, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
Naval Medical Center San Diego, Department of Surgery, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
J Pediatr Surg. 2025 Feb;60(2):161680. doi: 10.1016/j.jpedsurg.2024.08.020. Epub 2024 Aug 16.
Infants with esophageal atresia and tracheoesophageal fistula (EA/TEF) are at increased risk for respiratory compromise and gastric perforation until fistula ligation. We sought to describe current practice regarding the timing of EA/TEF repair and hypothesized that age at repair is a predictor of adverse outcomes.
The Pediatric Health Information System (PHIS) database was used to identify patients with EA/TEF who underwent fistula ligation and esophago-esophagostomy at US children's hospitals from July 2016-June 2021. Patients with a repair >10 days of age, a long-gap atresia, or H-type fistula were excluded. Comorbidities including prematurity and operative congenital heart disease were noted. Outcomes including anastomotic leak, gastric perforation, and post-operative respiratory failure were assessed for association with age and day of the week of operation.
Among 863 patients that were evaluated, the plurality of operations was on DOL 2 (36%) and 83% were on a weekday (random rate = 71%). Later operations had shorter LOS (p = 0.04) and more recurrent nerve injuries (p = 0.01). Weekend repairs were associated with equivalent outcomes. Gastric perforations occurred in 18 (2.0%) patients; 11 (61%) of these occurred after DOL 2.
We found no significant differences in outcomes other than more recurrent nerve injury and decreased LOS with EA/TEF repair at older ages. Although repair beyond DOL 2 was safe from a respiratory standpoint, most gastric perforations occurred after this point. In the absence of contraindications or significantly reduced weekend capabilities, we recommend repair of EA/TEF by DOL 2.
III.
食管闭锁合并气管食管瘘（EA/TEF）的婴儿在瘘管结扎前发生呼吸功能不全和胃穿孔的风险增加。我们试图描述目前关于EA/TEF修复时机的做法，并假设修复时的年龄是不良结局的一个预测因素。
使用儿科健康信息系统（PHIS）数据库来识别2016年7月至2021年6月在美国儿童医院接受瘘管结扎和食管-食管造口术的EA/TEF患者。排除修复时年龄>10天、长间隙闭锁或H型瘘的患者。记录包括早产和手术性先天性心脏病在内的合并症。评估包括吻合口漏、胃穿孔和术后呼吸衰竭在内的结局与年龄和手术日的关联。
在863例接受评估的患者中，大多数手术在出生后第2天（36%）进行，83%的手术在工作日进行（随机率=71%）。较晚进行手术的患者住院时间较短（p=0.04），喉返神经损伤复发较多（p=0.01）。周末修复的结局相当。18例（2.0%）患者发生胃穿孔；其中11例（61%）发生在出生后第2天之后。
我们发现，除了年龄较大时进行EA/TEF修复会导致更多喉返神经损伤复发和住院时间缩短外，结局没有显著差异。虽然从呼吸角度来看，出生后第2天之后进行修复是安全的，但大多数胃穿孔发生在这之后。在没有禁忌证或周末手术能力显著降低的情况下，我们建议在出生后第2天进行EA/TEF修复。
III级。
